Is My Mammogram Covered By My Insurance

Is My Mammogram Covered By My Insurance?

Breast cancer screening scans like mammograms can save lives—and that’s why it’s transparency about their cost and accessibility is so important. Under the Affordable Care Act, most health policies must cover certain elements of preventive care. That means there are no out-of-pocket costs as long as a patient qualifies with their insurer and stays in network. It’s easy to find an in-network provider when booking a mammogram or other scan on Medmo.com

What Is A Mammogram? 

A mammogram uses X-rays to create pictures of the areas inside the breast, which doctors can use to detect early signs of breast cancer. Mammograms are the most trusted scan used to detect breast cancer at any stage, and regular screening mammograms are the best tests for early detection far before symptoms appear. Patients diagnosed early experience much better outcomes: Those who find breast cancer at an early stage have a 98% survival rate, according to the CDC

Will Insurance Cover A Mammogram?

Before getting a mammogram, patients should check if they qualify under their insurer’s guidelines. Insurance companies reserve the right to decide whether or not a procedure like a mammogram is medically necessary.

Many insurers require that scans like CT and MRI undergo a “medical necessity review” to determine whether a procedure is appropriate and essential. Decisions are based on both the standard of care and the individual health plan’s policies and clinical guidelines. 

A single mammography screening isn’t always enough to detect breast cancer. Patients may need another mammogram, ultrasound, breast MRI, or biopsy—and while some states like New York require insurance companies to be responsible for full payment of some breast imaging services, that’s not always the case. 

So costs can add up, especially considering the wide range in not only what insurers will cover but also how much the follow-up scans cost. A diagnostic mammogram averages from $172 under Medicare to $239 with private insurance, while breast MRI costs an average $615 with Medicare and $1,073 with insurance, according to a 2019 study conducted by The Martec Group for Susan G. Komen. The safest way for patients to ensure tests will be covered is to call the insurer and ask.

Another option is to compare pricing from individual imaging centers to find the best deal. Done individually that would be time-consuming—that’s why Medmo offers set prices for scans at quality imaging centers. If your insurance doesn’t cover your test or if you’re not insured, Medmo can help you the best out-of-pocket price. And even for those with coverage, sometimes it’s a better deal to pay cash with Medmo’s negotiated rates.

Medmo connects patients with medical imaging prices they can afford, guaranteeing patients will receive the most convenient and affordable services at quality centers, as well as lowering their out-of-pocket costs, even with insurance. 

To book a breast cancer screening, visit us at Medmo.com. Medmo helps people schedule radiology imaging tests—such as MRI, CT scans, PET, and more—at nearby accredited centers and identify the payment solution that works best for them.

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